| NPI | 1659779346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MI 5302034096) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034096) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 5302034096) | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2020-01-18 |